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Best Treatment for Flaky Facial Skin from Dandruff and Rosacea

ask a dermatologist a questionHello Dr. Bailey, I just love your newsletter and blog posts; I have learned so very much from you. I have had rosacea for at least 15 years. I have been on the sulfacetamide lotion, Metrogel, and Finacea gel. I had stopped using the sulfacetamide lotion for 2 years. I thought my rosacea was getting better. This year I was diagnosed with seborrheic dermatitis (facial dandruff) on my face out of the clear blue. My dermatologist put me on Noble Zinc Soap, sulfacetamide lotion (night & morning), ketoconazole cream at night, and Finacea Gel in the morning. Since reading your blog I now use the Replenix Power of 3 Cream. What a beautiful cream and what a difference it has made in my skin. I also bought the eye cream because of your review on it, and what an anti-aging difference that has made. My questions is, I think that the Finacea is slightly drying my face, I use it first before the Replenix because I like to use the Replenix as my moisturizer. Do you think I should stop using the Finacea? Is it bad for my seb dermatitis, because I still see the dry skin around my nose area a bit. Could the Finacea be preventing a total clear up of the facial dandruff? I was just thinking of using the zinc soap, the sulfacetamide lotion and the Replenix cream. Thank you very much for your help! Laura B.   Hello Laura, Thank you for your kind words about my blog and newsletter; I'm glad you've found helpful information here. I can give you general information about how I handle this combination of skin problems in my practice. You can discuss this information with your dermatologist. Both rosacea and facial dandruff (seborrheic dermatitis) can cause rashes that result in red flaking facial skin, but the facial dandruff is more likely to cause flaking in the creases of the nose. What's really important to know is that the rashes from both facial dandruff and rosacea cause a compromise to your skin barrier integrity. This means that the involved skin is very easily irritated by harsh products. It's also more sensitive to harsh climactic conditions or strong skin cleansers. Seborrheic dermatitis (facial dandruff) and rosacea often coexist, as you have experienced. They can flare up together or one at a time. I tell my patients who suffer from this frustrating combination of skin problems, when either of these conditions has become persistent then we need to protect the involved skin from everything that is irritating. This allows the rash to subside so that the skin barrier integrity can be repaired. The process requires applying only non-irritating products to the skin so it can recover. I call this a Rosacea or Seborrheic Dermatitis Cool-Down. This "cool-down" skincare routine is important because applying irritating products to barrier-compromised skin is like squeezing lemon juice on a cut, meaning it prolongs inflammation and slows healing. Healing of the compromised skin barrier is supported by the using only bland moisturizers and soothing products. Unfortunately, Finacea can be irritating to some skin types. There is individual variation in terms of product tolerance and I always ask patients what products their skin tolerates and what products it doesn't. For the "cool down" we use only products their skin tolerates well.

Rosacea or Facial Dandruff Cool-Down Skin Care Routine for my dermatology patients:

Twice daily, cleanse facial skin with one of the following cleansers (they can be alternated depending on skin tolerance and need):

Toleriane Cleanser For Sensitive Skin


medicated rosacea facial cleanser

  • Sodium Sulfacetamide Prescription Cleanser
The latter two products can dry or irritate some people so the question of skin tolerance is important in picking which cleansers we use for the cool down.

After cleansing, I have my patients apply in this order:

  1. Green Tea Antioxidant Skin Therapy/Replenix Power of Three or Replenix CF Cream because the skin's antioxidant reserve is stressed by inflammation. I believe the antioxidant replenishment is one of the main reasons that the Green Tea Antioxidant Therapy/Replenix Power of Three makes such a big difference for healing facial dandruff and rosacea.Green Tea Antioxidant Skin Therapy
  2.  Clotrimazole cream to calm seborrheic dermatitis where it has been flaring up.
  3. A soothing moisturizer to all of the facial skin that feels like it needs a richer moisturize. Good options include my Daily Facial Moisturizing Skin Creams matched to your skin type. 
My Seborrhea and Rosacea Cool-Down Skin Care Routines also may include:
  • Prescription medicaments that are non-irritating to treat rosacea or seb derm, if necessary (e.g. Cleocin Lotion, Sodium Sulfacetamide Lotion, Metrogel, or Metro Cream and occasionally permethrin cream, all according to their dosage requirements). I usually have my patients apply these after the Green Tea because products with lighter bases are often better applied before those with heavier bases.
  • A very mild cortisone cream such as 1% hydrocortisone cream. I have them use this only where the rash is red, and for usually no more than 2 weeks. I, as my patient's treating physician, always supervise the use of this because there are side effects. I only use "non-halogenated" (a term a doctor will understand) cortisone products on the face.
  • Pure mineral zinc oxide sun protection, because both of these skin conditions can flare-up from sun exposure. Pure mineral zinc oxide sunscreens that are non-irritating and perfect for sensitive (aka barrier compromised) skin include Suntegrity 5 in 1 BB Cream, Glycolix Elite Sunscreen, or Suntegrity Baby Sunscreen.

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glycolix elite mineral zinc oxide sunscreen

dermatologist recommended natural broadspectrum sunscreen

I have my patients do this Cool-Down Skin Care Routine for 2 months, which is what is necessary to settle down skin inflammation. Stopping too soon results in relapse. It takes a month or more for the skin barrier to heal AFTER the inflammation has subsided so it is important to be patient and not to add irritating products back too soon. I hope that helps.  Thanks for a really good question that I know other people share. Warm Regards, Cynthia Bailey MD Reference: Why is Rosacea Considered to Be an inflammatory Disorder?  The Primary Role, Clinical Relevance, and Therapeutic Correlations of Abnormal Innate Immune Response in Rosacea-Prone Skin.  Del Rosso J Q et. al., J Drugs Dermatol. 2012;11(6):694-700. Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.